Open AccessCurrent evidence of nutritional therapy in pancreatoduodenectomy: Systematic review of randomized controlled trials
Author(s) -
Takagi Kosei,
Domagala Piotr,
Hartog Hermien,
Eijck Casper,
Groot Koerkamp Bas
Publication year - 2019
Publication title -
annals of gastroenterological surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.308
H-Index - 15
ISSN - 2475-0328
DOI - 10.1002/ags3.12287
Subject(s) - medicine , synbiotics , randomized controlled trial , perioperative , systematic review , medical nutrition therapy , parenteral nutrition , intensive care medicine , malnutrition , tolerability , medline , cochrane library , nutritional supplementation , meta analysis , enteral administration , surgery , adverse effect , genetics , probiotic , bacteria , political science , law , biology
Aim Evidence of nutritional therapies in pancreatoduodenectomy ( PD ) has been shown. However, few studies focus on the association between different nutritional therapies and outcomes. The aim of this review was to summarize the current evidence of nutritional therapies such as enteral nutrition ( EN ), immunonutrition, and synbiotics on postoperative outcomes after PD . Methods A systematic literature search of Embase, Medline Ovid, and Cochrane CENTRAL was done to summarize the available evidence, including randomized controlled trials, meta‐analyses and reviews, regarding nutritional therapy in PD . Results A total of 20 randomized controlled trials were included in this review. Safety and tolerability of EN in PD was shown. Giving postoperative EN can shorten length of stay compared to parenteral nutrition; however, the effect of EN on postoperative complications remains controversial. Postoperative EN should be given only on selective indications rather than routinely used, and preoperative EN is indicated only in patients with severe malnutrition. Giving preoperative immunonutrition is considered to reduce the incidence of infectious complications; however, evidence level is moderate and recommendation grade is weak. The beneficial effect of perioperative synbiotics on postoperative infectious complications is limited. Furthermore, the effectiveness of other nutritional supplements remains unclear. Conclusion Recently, evidence of enhanced recovery after surgery ( ERAS ) in PD has been increasing. Early oral intake with systematic nutritional support is an important aspect of the ERAS concept. Future well‐designed studies should investigate the impact of systematic nutritional therapies on outcomes following PD .